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Brachial Plexus Injuries. Professor Muhammad Rafique. Typical Spinal Nerve. Assisted Labor. Difficult Labor. Breech Presentation. Parturition. During the process of delivery a slight force is applied at the head to drag the baby out of the birth canal. - PowerPoint PPT Presentation
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Typical Spinal Nerve
Assisted Labor
Difficult Labor
Breech Presentation
Parturition During the process of delivery a slight force is applied at the head to drag the baby out of the birth canal. If the force is severe it may damage the brachial plexus More common on right side and usually upper roots C5 and C6 and sometime C7 roots injured
Sing
Symptoms
Begin with a letter “Y”, an “I” and a “Y”.
Add a “strike” and a “spare” (bowling scorekeeping symbols)
Draw “arches”.
Draw horizontal lines to separate the parts.
Roots
Trunks
Divisions
Cords
Branches
Roots
Trunks
Divisions
Cords
Branches
Begin labeling.C5 C6 C7 C8 T1
Upper Middle Lower
Musculocutaneous Axillary Median Radial Ulnar
Late
ral Pos
teri
or
Med
ial
SLOW
Add details . . .Branches off the posterior cord spell “ULTRA”
Axillary Radial
C5 C6 C7 C8 T1
Roots
Trunks
Divisions
Cords
Branches
Upper Middle Lower
Musculocutaneous Median Ulnar
Late
ral Pos
teri
or
Med
ial
Upper subscapularLower subscapularThoracodorsal
SLOWSLOW
“3M” comes off the medial cord.
Axillary Radial
Roots
Trunks
Divisions
Cords
Branches
C5 C6 C7 C8 T1
Upper Middle Lower
Musculocutaneous Median Ulnar
Late
ral Pos
teri
or Med
ial
Upper subscapularLower subscapularThoracodorsal
Medial pectoral n.Medial cutan. n. of armMedial cutan. n. forearm
SLOWSLOW
The lateral pectoral n. comes off the lateral cord.
Axillary Radial
Roots
Trunks
Divisions
Cords
Branches
C5 C6 C7 C8 T1
Upper Middle Lower
Musculocutaneous Median Ulnar
Late
ral P
oste
rior M
edi
al
Upper subscapularLower subscapularThoracodorsal
Medial pectoral n.Medial cutan. n. of armMedial cutan. n. forearm
Lateral pectoral n.
There are 4 supraclavicular branches.
Axillary Radial
Roots
Trunks
Divisions
Cords
Branches
C5 C6 C7 C8 T1
Upper Middle Lower
Musculocutaneous Median Ulnar
Late
ral P
oste
rior M
edi
al
Upper subscapularLower subscapularThoracodorsal
Medial pectoral n.Medial cutan. n. of armMedial cutan. n. forearm
Lateral pectoral n.
Dorsal Scapular n.
N. to subclaviusSuprascapular n.
LongThoracic n.
SLOW
That’s it! The Brachial Plexus
Axillary Radial
Roots
Trunks
Divisions
Cords
Branches
C5 C6 C7 C8 T1
Upper Middle Lower
Musculocutaneous Median Ulnar
Late
ral P
oste
rior M
edi
al
Upper subscapularLower subscapularThoracodorsal
Medial pectoral n.Medial cutan. n. of armMedial cutan. n. forearm
Lateral pectoral n.
Dorsal Scapular n.
N. to subclaviusSuprascapular n.
LongThoracic n.
Different Parts of Brachial Plexus in Relation to Clavicle
Supra-Clavicular Part–Roots, Trunks
Retro-Clavicular Part–Divisions
Infra-Clavicular Part–Cords, Branches
Relation of Cords of Brachial Plexus with Axillary Artery • Axillary Artery divided into
three parts 1st, 2nd and 3rd part by means of Pectoralis minor muscle.
• The cords of brachial plexus surround the axillary artery.
• On the 2nd part of axillary artery the cords of brachial are lying lateral, medial and posterior, that’s why they are named
Causes of Brachial Plexus Injuries A birth brachial plexus injury is thought to be caused by an injury involving the child's brachial plexus during the delivery process. This injury results in incomplete sensory and / or motor function of the involved arm.Traumatic brachial plexus injuries may occur due to motor vehicle accidents, bike accidents, ATV accidents, sports, etc. Nerve injuries vary in severity from a mild stretch to the nerve root tearing away from the spinal cord.
Causes of Brachial Plexus Injuries The nerves of the brachial plexus can be injured during a difficult delivery from:The infant's head and neck pulling toward the side as the shoulders pass through the birth canalPulling on the infant's shoulders during a head-first deliveryPressure on the baby's raised arms during a breech (feet-first) delivery
Types of Brachial Plexus Injuries Erb's PalsyKlumpke's PalsyComplete Palsy
Types of Brachial Plexus Injuries Erb's PalsyC5, C6 and sometimes C7 nerves are involvedOften presents with arm straight and wrist fully bent (waiter's tip)May have good hand function but not full movement of the armMay have instability of the shoulder jointOften presents with weak biceps and deltoid muscles (unable to bend elbow or lift arm at the shoulder)Includes about 75 percent of all brachial plexus injuries
Complete Damaged to Brachial PlexusWhen all five nerves in the brachial plexus are injured it is called Complete Brachial Plexus palsy. The child loses the ability to face forward for any length of time (called torticollis) and is sometimes also afflicted with an eyelid droop on the same side of the affected hand/arm and constriction of the pupil (Horner’s Syndrome). When paralysis occurs in both the arm and hand, it is called Klumpke’s palsy.
Klumpke's Palsy(1% of cases) - involves C8-T1; newborn will be unable to grasp or flex wrist. If sympathetic fibers of T1 are involved, there may be an ipsilateral ptosis and miosis (Horner's syndrome). This pattern of injury is much less common than Erb's. Prognosis is also poorer than Erb’s.
SymptomsSymptoms can be seen immediately or soon after birth, and may include:Newborn is not moving the upper or lower arm or handAbsent Moro reflex on the affected sideArm flexed (bent) at elbow and held against bodyDecreased grip on the affected side
Moro ReflexThe Moro reflex is a normal reflex for an infant when he or she is startled or feels like they are falling. The infant will have a "startled" look and the arms will fling out sideways with the palms up and the thumbs flexed. Absence of the Moro reflex in newborn infants is abnormal and may indicate an injury or disease.
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